The Tsai Family

Shaping Family Values

Vivian Tsai underwent surgery at Mayo Clinic in 2015 and because of her experience decided with her family to give back to research hypertrophic cardiomyopathy.

Paul and Ruby Tsai raised their children, Joseph, Eva, Vivian and Benjamin, on the values of their faith, a dedication to excellence and the desire to give back to others. Paul and Ruby built the foundation of their family on these core values, teaching their children to always think beyond themselves.

Paul led by example. In 1953, he was accepted to Yale Law School and was the first graduate student from Taiwan to earn a doctor of juridical science from Yale.

When he returned to Taiwan, Paul served as a prominent attorney and government official. He played a key role in developing policies and legislation that advanced Taiwan's international economic leadership, including laws that contributed to Taiwan's Economic Miracle, a time of rapid industrialization and economic growth that began in the 1960s. In recognition of his outstanding civil service, Paul received the President's Award for Outstanding Performance in Government Services in 1963.

In 1965, he and his father, Ruchin Tsar, established a private law firm, Tsar & Tsai, which is now one of Taiwan's largest firms, with a reputation for quality and innovation. As his personal success grew, Paul became a generous philanthropist. An internationalist at heart, Paul contributed generously to humanitarian organizations at home and abroad.

"We know our father was a generous donor to the Christian community and universities in Taiwan, the U.S. and Canada. Through his Rotary Club, he was also a big supporter of projects which helped children with polio," says Vivian. "He did so much, but most of his acts of generosity have gone unrecognized."

As for Ruby, she has also served as a strong role model for her children by devoting most of her life to charity and volunteer work related to women's rights and issues. In Taiwan, she's served on the boards of the YWCA since 1974 and on the National Council of Women since 1990.

"My mother is so serious and diligent with her work at the nonprofit organizations," says Eva. "My mother never talks about how much she contributes, but she is always concerned about the needs of others."

Ruby is an active participant in the National Women's League, serving as executive director for the past 15 years. As generous as her late husband, Paul, was, Ruby also supports Christian organizations with her time and financial resources. She takes great pride in her charitable work, because it gives her happiness to see the needs of others being met.

"It is more blessed to give than to receive," says Ruby, reciting a cherished verse from the Bible.

These core values continue to be an integral part of the Tsai family — a piece of their genetic makeup.

A Journey Across the World

When Paul was 82 years old, he recognized something seemed wrong with his youngest daughter, Vivian, who was beginning to experience familiar medical symptoms. She remembers the last words he said to her: "See a doctor. You have the same thing I have."

Over time, Vivian's symptoms had taken hold of her life, affecting her daily activities. She was not able to talk for more than 30 seconds without losing her breath. While eating dinner, Vivian would often lie down for half an hour before returning to her meal because she would become so tired and lightheaded.

Vivian's fear of having arrhythmia attacks also hindered her professional and social life. Gripped by this fear, she stopped driving and eventually sold her car. Vivian's fear further intensified in 2014 after she experienced two episodes of transient ischemia attack, an episode that produces similar symptoms as a stroke but lasts only a few minutes and causes no permanent damage. Since then Vivian was afraid to go out by herself because she felt she would pass out on the street.

"The condition — and not having a clear idea of its cause — weighed on Vivian. It weighed on all of us," says Benjamin, the youngest of the Tsai siblings.

In Taiwan, Vivian was told she had a heart condition called hypertrophic cardiomyopathy (HCM), but nobody really explained the problem to her. Realizing that her father's words were a call to action, she decided to be her own health care advocate and turned to a friend who is a cardiologist in the United States. He urged her to visit Mayo Clinic.

However, Vivian was skeptical, until she discovered an educational video on Mayo Clinic's website of Hartzell Schaff, M.D., a cardiovascular surgeon, explaining the surgical treatments available to hypertrophic cardiomyopathy patients.

In June 2015, accompanied by Benjamin and his wife, Emily, Vivian came to Mayo Clinic for an evaluation and diagnosis. She met with cardiologist Rick Nishimura, M.D., who gave her shocking news. Dr. Nishimura, Terrance D. and Judith A. Paul Director of MayoExpert, explained that Vivian had apical hypertrophic cardiomyopathy but had developed an undiagnosed apical aneurysm, which is a complication of apical hypertrophic cardiomyopathy.

This development was causing her exercise limitations as well as putting her at high risk for blood clots and heart rhythm abnormalities. He recommended Vivian meet with Dr. Schaff, the Stuart W. Harrington Professor of Surgery, to discuss the possibility of a procedure that she was told by physicians in Taiwan did not exist: a transapical myectomy.

This procedure, developed and perfected by Dr. Schaff and his team at Mayo Clinic, enables the surgeon to go in through the bottom of the heart to remove the diseased muscle in parts that were previously unreachable.

With renewed resolve, Vivian underwent surgery in September 2015.

"The strongest impression I got was how convicted Vivian was with wanting to get the surgery. She was very firm that this was what she wanted to do, and that speaks to her personality," says Joe, the eldest of the Tsai siblings. "After living under stress and uncertainty, Vivian wanted to take matters into her own hands."

Almost every day post-surgery, Vivian went to Mayo Clinic's Cardiac Rehabilitation Program within the Cardiovascular Health Clinic. She says she credits the program with having a pivotal effect on her recovery. After a two-month stay in Rochester, Vivian returned home symptom-free.

A Compelling Experience: A Transformative Gift

After this lifesaving experience, Vivian says she felt compelled to do something meaningful — something that could show her respect and gratitude to the medical professionals and doctors who cared for her. Vivian shared this idea with her mother and siblings, who immediately agreed to join her.

"We all agreed that, if our father was alive, he would be happy to see this happen," says Vivian.

In honor of their parents and the core values they instilled in each sibling, the family's gift recognizes medical excellence and innovation at Mayo Clinic. Support from the Tsai family also honors Vivian's care team, led by Drs. Nishimura and Schaff, by establishing two awards that help young investigators make significant career-long contributions to hypertrophic cardiomyopathy research and the care patients like Vivian receive.

The Tsai family's endowment will also help Mayo Clinic understand the genomics of hypertrophic cardiomyopathy, study clinical outcomes of current patients and innovate to discover the best ways to treat patients.

The Tsai family's gift helps perpetuate Mayo's leadership in patient care, research and education in hypertrophic cardiomyopathy. Not only will this gift benefit Mayo Clinic patients but patients throughout the world, including East Asia, where the Tsai family calls home.

"Mayo Clinic is a place with the right mission, the right values, which attracts the right people," Joe says. "Giving to Mayo was the perfect way for Vivian and for all of us to show our appreciation and gratitude."

Hypertrophic cardiomyopathy (HCM) is a disease in which the heart muscle becomes abnormally thick and is usually caused by a genetic mutation. The thickened heart muscle can make it harder for the heart to pump blood and can cause problems in the heart's electrical system, resulting in life-threatening abnormal heart rhythms.

"Patients may have symptoms that include shortness of breath, heart palpitations or chest pain. A proper examination and further testing, such as an electrocardiogram
and echocardiogram, are needed to make a diagnosis," says Dr. Nishimura, he Judd and Mary Morris Leighton Professor of Cardiovascular Diseases and Hypertension in Honor of Dr. Alexander Schirger. "Most patients with this condition can be treated with medication, if given properly."

Diagnosis can be challenging. The most common symptoms occur during exertion and include shortness of breath, chest pressure, fainting or fatigue, and heart palpitations.

HCM is often caused by a complex genetic mutation that can be inherited. Diagnosed individuals may consider genetic testing to assess risk to family members.

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